I recently had a patient who I could not help. Shocking, I know. But seriously, I was not able to help this particular person move better, feel better, or function better.
My patient had unfortunately been in a car accident a few months ago, and after the accident she attended physical therapy and chiropractic at another clinic. At this clinic she recieved passive treatments like heat, ultrasound, and laser treatments.
She continued with pain, and so her doctor once again referred her to physical therapy. She chose my clinic because of my specialist certification in the McKenzie Method.
When I first evaluated this patient, she reported worsening pain in a diffuse nature. She hurt everywhere--in her neck, arms, legs, low back, and head. While talking with her, she reported that her pain was constant and never got better. She said it only changed from "worse" to "not as worse." After I heard her say that, I knew this would be a challenge.
My clinical examination of the patient revealed a loss of range of motion at almost every joint in the body. But the loss of motion was really just a patient who was too anxious to move. And every motion made her pain worse. No motion and no position seemed to offer any relief. (I wrote about NoMo/NoPo in a previous blog.)
I tired to encourage this patient, explaining that movement can help her condition. She attended three or four PT sessions with no improvement. At every appointment, she inquired about receiving ultrasound and laser treatments, just like she had at her previous physical therapy clinic.
Now, I am a pretty mechanically minded person, so I am a little biased about passive physical therapy treatments. I also know what many of the studies about ultrasound and laser treatments for pain and movement dysfunction show--not much promise for improvement. Plus, this patient already had those treatments, and she reported that her condition was worsening, not improving.
After a few sessions of encouragment and answering questions about passive treatments and their lack of expected benefit, my patient and I agreed that she should attend physical therapy at another clinic. I just was not offerring her what she wanted, or what she felt she needed.
What I did offer was my honest clinical opinion. Movement can help. Exercise can help. Rubbing the body with lasers or ultrasound wands is probably as effective as rubbing the body with peanut butter.
I know some people would argue that I should have just given the patient what she wanted so she would perceive improvment. Perhaps she would actually feel better with these passive treatments, but I cannot in good conscious offer something to a patient that I feel would not really help. (And I don't own a laser.)
One of the most important aspects of my job is to make decisions. I decide what to evaluate, what is an important piece of information, and what exercises to prescribe. One of my most important decisions is deciding on who I can help and who I cannot help. I treat those who I feel I can help. If I determine that I cannot help a patient, I at least assist him or her in finding someone who may (possibly) help.
And I don't shoot my patients with lasers.